Happy Second Birthday Little Man

Dear Best Little Boy,

What a wild roller coaster of a ride your last year has been. We have seen some terrifically high highs and some terribly low lows, but it has been a year of learning, of new adventures, new paths, and celebrations. We have dealt with intensive feeding therapy, dental surgery, speech, OT / PT / ABA / developmental pediatricians and diagnoses. We have learned about therapies and procedures and interventions we had never heard of before this year. We have learned to navigate the 'system', to advocate for you, to support you.

We have fretted and worried and cheered and celebrated. You have taught us to appreciate the little milestones - the next words, accepting food, the first initiated hug, the development of preferences and favorites. You have taught us that sometimes development happens seamlessly and naturally, and sometimes it needs a little coaxing and encouraging and that's okay. There is no one right or acceptable path of development, and each child is different, has strengths and challenges, but is unique and wonderful in his or her own right.

You have taught us that despite the stress, the anxiety, the worry, that in fact, this too shall pass. You have opened our eyes to a world of firetrucks and dogs, of Elmo, Cookie Monster and balls and wheels. You love animals and babies. You have shown us that little boys can have some sweet dancing moves. You have reminded us to appreciate the simple things in life like ice cream, and watermelon and even simple physics. Yes, gravity does work, and it is pretty cool, and I understand why you feel compelled to drop things over the banister again, and again, and again and again...

You have taught us that you should be your own best cheerleader - with so many people working with you and helping you, every time you accomplish anything you holler, "YAY! HURRAY! WOO!" If you have no cheering squad, be you own!

You have helped me laugh at my pre-you self, where I thought I had things to worry about, but also reminded me that there are others with far more significant worries than my own. You have astounded us all with your remarkable growth, and your knack for noticing everything and appreciating your world with wonder.

You are spunky and opinionated (your favorite words are 'no' and 'mine'). You love your sister, but equally love your personal space and have a jealous streak. You love anything that rolls or makes noise or lights up. You have a contagious giggle and a smile that lights up a room. You adore your Mama and your Daddy and you have 'Mayor of Brooklyn' qualities, much like your sister before you. As we go down the street, you wave to everyone and say "Hi. How are you?"

You are not only walking but running. You want to run EVERYWHERE. 'Enne! Enne' is your cry as you take off down the sidewalk. Like your sister as well, you can't pronounce the German 'R' yet, so rather than 'Renne Renne' you run run without the r.

You have FINALLY found a lovey, and attached to a scruffy little cat stuffed animal that you call 'kitty kitty' and you like to take her everywhere. You love pizza and rice but still aren't a terrific eater but you are EATING, and that is something we couldn't say a year ago. You actually ATE your birthday cupcake.

Despite the challenges of the past year and the paces you have put us through, we can't imagine our family without you. You complete our family, fill our hearts and our home with love and energy. You amaze us with your growth and your learning and your perseverance. We are cheering you on little man, watching you with joy and pride, and anticipating more wonderful things to come as we look forward to the next year. We can't wait to see what you have in store this year!

We love you our best boy,

Love,

Mama

New Year's Resolutions, 2011

It's been a long, challenging fall this year. In September I returned to work and we resumed the challenge and struggle of juggling home responsibilities with two parents in the workforce. This challenge was further complicated by Julia's start in full-time, real-deal school as a kindergartner, and an extensive therapy schedule for Mister Man. At the time I returned to the classroom in September, it was OT 2x per week, PT 2x per week, and Speech and Feeding 2x per week as well.

We headed back to the state for our 6 month review and to request an increase in his speech therapy in November. At almost 18 months, he still wasn't really talking, and he (and we) were getting increasingly frustrated. The state requested a psych evaluation, to determine if anything else was going on to impede his language development. We were sure it was just a technicality. Our speech therapist and our OT assured us it was just a technicality. Imagine how overwhelmed we were when the psychologist showed up, observed our son for about 20-30 minutes, and diagnosed him as PDD-NOS (Pervasive Developmental Delay, Not Otherwise Specified - read: on the autistic spectrum). Now let me qualify, the psychologist was supposed to come at 5:30 PM, didn't show until 7 PM because of traffic and delays, and by that time Oliver was tired, cranky, hungry and running around like a tornado on crack. Anyone with children knows that is the PERFECT time to assess an 18 month old. HA.

We weren't sure about this diagnosis, so we sought out a developmental pediatrician at Cornell Medical Center on our own, and within 5 minutes she assured us he wasn't PDD-NOS, that his eye contact was too good, he was visually referencing everything that was going on in the room, looking from person to person during a conversation, etc. So a relief to be sure. However, with the new 'diagnosis' on Oliver's chart, his speech therapy increased to 5x per week, which we were thrilled about, and he received a behavioral therapist who would focus solely on helping him develop communication and life skills, and also help him develop self-soothing strategies. Right now his self-soothing strategy is... Mama. So Mister Man has 15+ hours of therapy a week. That's a lot of therapy for a little boy.

However, he has made TERRIFIC gains in the past 6 months. He has gone from sitting unsteadily to running, and pushing himself to stand in the middle of a room. He is signing please by clapping, saying 'Mo' for more, waving good bye and saying "Buh!" for bye, and announcing "HI!" when he walks into a room. He calls me Mama, Dave Daddy, and Julia is Oo-ah. Chloe, the cat, is 'Me-ow!" He is eating, though in the last three months he has grown 2 1/2 inches and lost 1/2 a pound... so we have work to do there.

As if all of these assessments, therapists and sessions weren't challenging enough, back in the early fall, I started noticing some staining on Oliver's teeth. While at Julia's 6 month cleaning, I asked the dentist to look in Oliver's mouth. She asked me to make an appointment to have a full cleaning done. THAT was fun. I took a full day off from work in anticipation of the mental recovery we would both need. It was necessary. Long story short? Oliver has cavities in EVERY ONE OF HIS SIXTEEN TEETH. Seems the acid reflux, the months of throwing / spitting up, the esophagitis, the medicine for the esophagitis all destroyed his teeth. In January, poor little boy will undergo anesthesia for the SECOND TIME in his short life, this time for 4-6 baby root canals, at least 4 crowns (two stainless and two polymer) and 10-12 fillings. Add to this the fact that Dave's dental insurance maxes out at $2,500 per patient per year, and you can imagine this is all pretty anxiety provoking. Our beach vacation may end up in Oliver's mouth this year. We are waiting on the estimate and crossing our fingers that our medical insurance will cover the anesthesia and not deem Oliver's dental work as 'elective.' You know, because cavities in EVERY ONE OF HIS TEETH caused by a MEDICAL CONDITION is elective.

Dave and I joke that Oliver is going to be crossing old ladies across the street in his teen years, be the captain of the basketball team, and get a full ride to Yale, while running drug abuse prevention programs in lower schools across NYC. Because he is using up his quota of parental worry before his second birthday.

Well, the countdown is on to the New Year, and this year instead of resolving the usual (you know, eat healthier, lose 10 pounds, run 4x per week, take time for me...) I am resolving to be a better Mom.

I have those moments where self-doubt creep in... (Did I do something / not do something / expose him to something / etc. etc. etc. _____ fill in the blank - when I was pregnant? Did he not get the stimulation that Julia did? Did I not have enough one on one time?)

And the moments where I compare... (When Julia was 12, 14, 18 months old she was ______)

And the moments when I struggle to find the patience... (I don't know if I can handle five more minutes of the whining... can you PLEASE FIND SOME WORDS TO TELL ME WHAT YOU WANT.)

And the moments of deflected frustration... (JULIA WHAT DO YOU WANT?? - as Oliver is hanging from my leg crying and I am trying to brush my teeth).

So this year, my resolutions are simple:

• Celebrate, savor the small moments, the small accomplishments, the tiny milestones.
• Live in the moment, banish the 'if-only's' from my mind and my vocabulary.
• Don't compare, celebrate the uniqueness and individuality of each child.
• Spend quality time with each child, every day, and find a moment, even if it is just a moment, for my husband and for myself. It makes me a better Mom.
• Breathe. Breathe again. And once more.

Last Day of Preschool

So, today is Julia's last day of preschool. It’s hard to believe three years have flown by so quickly. I remember sitting in our new parent orientation session three years ago and feeling incredibly nervous. Our girl was so big yet so tiny. She wasn’t even two yet, but we were enrolling her in preschool? It was so beyond our frame of reference – Dave and I both started preschool when we were four years old. Did we really need to enroll Julia at the age of two? How would she make it through 2 ½ hours without her lovey, Puppy? She was still in diapers, how would that be managed? She really hadn’t spent any extended time with any adult other than the two of us and Sherrie, her nanny. Would these teachers at Cobble Hill Playgroup appreciate her energy, her spunk, her quirkiness, her sensitivity? We decided to view Julia’s first two years of preschool as an organized playdate, and if nothing else, hope she learned that there were expectations and rules for working together in a classroom environment. What happened was beyond our wildest expectations.

First day of phase in, Julia was so excited to be at school, though she still wasn’t quite sure what school was. A bigger boy was building an intricate tower of blocks. Julia marched over to him, and smacked the tower down. When the bigger boy protested, she then proceeded to hit HIM. I watched, a little horror stricken, but interested to see how the teachers would react. A teacher walked over to Julia, removed her from the situation, and got her set up with another activity, away from the clearly upset older boy. In that moment I was sold. Age appropriate, gentle, but effective classroom management. The message was clearly sent that hitting and knocking down someone else’s work is not acceptable, but not with an admonishing, demeaning tone.

The routine of school quickly became a part of our family’s week. Daddy walked Julia to school (rather, strolled her to school those first two years), our sitter picked her up. After a while, we forgot we were writing tuition checks. It was just a place Julia went twice a week. Most days the only information we got about school was that she sang “Old-De-Donald” and that she pooped in her diaper. And then magic happened. Julia and I were waiting on the train around December. The train pulled into the station and Julia said, “Look, the 4 train!” and it was. And I hadn’t taught her what a four looked like.

Many moments have happened since then that have reinforced our choice to send Julia to preschool at the tender age of two. She has thought about her role in the world, learned about recycling and holidays, and owl pellets and words. She has learned to spell, learned to read, and overcome her intense phobia of worms through a worm study. She has learned to get along with others and that school has a routine and a predictability to it. She has learned to ask questions and satisfy her curiosity. She has learned to LOVE school and LOVE her teachers.

I am dreading pick up today, dreading the final good-byes, dreading the heartfelt words that I know I will hear from her preschool head and teachers, dreading the tears that will inevitably come, dreading the end of this phase. Closing a chapter of your life is difficult, particularly when closing that chapter of your life means your baby girl is growing up and becoming more and more independent each day. I joke with Julia that I am going to strap a cinder block to her head because she is getting so big and tall and self-sufficient. But it's all relative. I remember thinking my big preschool girl was HUGE back in 2007. And look at her now.

Dear Oliver...

Dear Oliver -

Well, your big day has arrived. You (and we!) have made it your first trip around the sun, and what a wild trip it has been! A little over a year ago, as we brought the baby infrastructure up from the basement (the diaper champ, the crib, etc.) and the waves of realization hit me (we are going to have someone in DIAPERS again? We are going to be woken up at all hours? The early nursing... so hard! Labor and delivery... SO HARD!) I wondered how we were going to do it. I mean, my only frame of reference for having a baby was your sister, and for 3 1/2 years she'd had my undivided attention. When she was a newborn I didn't have to figure out how to take care of her and also parent a three year-old. How was this all going to work? How was I going to take care of a tiny, nursing around the clock, waking at all hours newborn and also be a Mommy to Julia?

I won't lie, there were some preposterous moments - some moments that made me feel like someone had stolen my very organized, in control life and given me this new, out of control, chaotic one in exchange. But somehow as a Mommy, as a FAMILY, we muddled on through and figured out how to expand our home, our life and our hearts as we transitioned from a family of three to a family of four. Looking back now, I can hardly remember what it was like to only have one child, because your arrival has made our family and our lives so much richer and more complete.

It has been amazing to watch you grow and develop from a little baby to a little boy, and I sometimes find myself staring at you in amazement as you sleep, amazed that your tiny body is not so tiny anymore, amazed that your little face looks like a little boy and not my little newborn. When did that happen? Did I blink a little too long? Find myself occupied by other things and forgot to notice when your body grew a little longer and your face grew a little older? I can't believe you are already one year old.

You have developed clear preferences at this point. You love Mama over everyone else. When you get fussy, 9 times out of 10 it is because you want Mama. When Daddy reaches his hands out to take you from me, you either turn and grip onto me like a little monkey, or you smack his hands away. You love your Daddy and Julia too - you squeal when you see them and your face lights up, but you LOVE your Mama. You love to bounce (whether on someone's arm or in your bumper jumper). You love to dance - the second you hear music, you start bouncing up and down on my hip and start squealing. You love your music class as well. And you love love love Chloe, the cat. When you see her, your little eyes sparkle and you beam!

You have favorite toys as well. Your very favorite toy is a set of stacking plastic cups. You love to have them stacked up into a tower so you can smack them down. You love anything you can knock over, anything that makes noise. You love sirens, wheels and balls. As though you innately know you are a boy and you are supposed to love those things.

We have had our ups and downs this year. You still aren't eating very much, after an endoscopy and two swallow assessments, and you are undergoing behavioral feeding therapy at NYU's swallow center. You haven't started to crawl or pull up either and you have also qualified for 7 therapy sessions per week under New York City's Early Intervention program. You will have physical therapy 2x per week, feeding therapy 2x per week, play therapy 2x per week, and occupational therapy 1x per week. You are growing and thriving, but you need a little help moving forward in some areas to become mobile, develop an appetite for solid foods, and explore and learn from your world. Your Daddy and I are going to see to it that you get all the help you need to become the best boy you can be.

Little boy, I am so privileged to be your mother, and am so thankful you chose me. I can't imagine my life and our family without you. You and your sister make me a better person each and every day. I can't wait to see what you have in store for the coming year, and can't wait to watch you continue to grow, thrive, and discover the world around you... I love you, my best boy. Happy First Birthday.

Love,

Mama

The Report

So... Oliver's evaluation report arrived yesterday. While I was bracing myself for it, it was still hard to digest and process. The therapists unanimously evaluated him as 'delayed' on all fronts. He was even graded with letter grades in one section of the report, and received several 'Fs'. While Dave and I have known for a while now that he was behind in several areas (I mean, this is our second go-round as parents, and what parents don't compare the second experience to the first), it was hard to read the report with his name at the top and 'delayed' in every evaluation, gross motor, fine motor, cognition, speech and language and feeding. To read that he could be in danger of failure to thrive if he doesn't start eating soon, as breast milk will no longer meet his needs when he becomes more active. To read he is weak. To read he isn't playing like a one year-old should. To read he doesn't understand simple commands, or mimic back sounds or imitate signs. It's true. All of it is true.

It's also difficult to not assign blame to myself. I am the one that is with him 24 hours a day, I am the one that spends the most time with him, I am the one, I am the one, I am the one. And as much as I would like to figure out a cause, or assign blame, or really determine what we did and didn't do in order to figure out how to 'fix' this, more than likely this is just Oliver, the lot he was cast, and now we move forward from here.

Our big meeting is May 20th, where we go in and discuss his challenges, set goals, and find out what services the state is willing to pay for, and where we develop our plan. And for those people that know me, I am a woman that likes to set goals, make a plan, and move forward. We find out our therapy schedule, and we will know what we are looking at for the next 6 months. Then we go in and review his progress and make a new plan.

Tuesday we head to NYU Hospital's Swallow Center to have a swallow assessment done and to make a plan to start behavioral feeding therapy to get this boy interested in some solid foods beyond just a couple of rice puffs, a few crumbs of bread and miniscule amounts of dried fruit. His birthday party is next weekend, and realistically he won't even eat the dairy free / soy free cupcakes that I plan to make... because he won't be interested.

As his first birthday approaches, I have found myself willing him to meet any major milestone, just to send up a flare that he is okay and making progress - crawl, move to all fours, clap, wave, ANYTHING. As if he could sense my increasing anxiety and panic, he has made some major progress in his gross-motor skills in the last week or so. He has learned to sit up from a prone position (HUGE), has learned how to roll from back to front, not just front to back, and is correcting himself more consistently when he leans too far to one side and loses his balance. Additionally, he seems to be understanding a little more lately. Day before yesterday when I asked him if he wanted to nurse, he grabbed my shirt and started pulling at it. We are moving forward, just not according to any milestone chart. We are moving forward at Oliver's pace.

So that's it. We find out our plan in the next few weeks, a plan of action, a plan of therapy, and we will see what our lives will look like for the next 6 months. And hopefully Oliver's progress will begin to move forward at a more expedited pace and he will come up to curve. We may not know for years what it is that we are dealing with, or even if there is any big picture challenge we are facing. For now, he continues to be our perfect little boy, my little love, and we will work to get him the help he needs to continue to grow, learn and thrive. And remind me when he is crawling all over my apartment and destroying our home that I wished for him to become mobile!

Reclaiming Adult Space

Julia is an artist extraordinaire. She is constantly working on her 'projects' in her play area, cutting and taping, and drawing and glittering, and wrapping... She brings projects home from school every day. She makes projects at home every day. Our small Brooklyn apartment is overrun with art, notes, pictures, and projects. AND, she wants to post these projects all over our home. She gets out her tape and tapes them up in the living room, her playroom, the kitchen, her bedroom, our bedroom, even the bathroom has displayed an occasional piece of her art.

This weekend Dave and I made a small effort to reclaim a little space of our own, moving some display shelves from her play area to the dining area of our living room (yup, no dining room, no living room, this is NYC we are talking about, where real estate is a premium), and putting up an art gallery wall in her play area. She insisted on having it written in German (a nod to our bilingual household) so it says "Cates-Addison Art Gallery" on the wall.

Compromise achieved. Our dining area now looks like a dining area, free of the 30 pieces of paper scotch taped to the wall, and her play area has a designated space for us to oohhh and ahhhh over all of her masterpieces...

Early Intervention...

Yesterday was Oliver's 11 month birthday. And he isn't eating. He will take a couple of crumbs of bagel, a couple of dried blueberries and that's all she wrote. For all intents and purposes, he isn't eating. He is still getting about 99% of his calories from nursing. After the swallow assessment and the endoscopy last month, we were directed to NYC's Early Intervention program to see if he would qualify for behavioral feeding therapy services. In order to qualify, he had to have a delay in at least one other area, so we have had a troupe of therapists parading through our home in the last two weeks. We've been assigned a case worker, and he's been assessed by a physical therapist, an occupational therapist, a speech and language therapist, and a teacher has done a general assessment and parent interview.

So here's where we freak out. Not only has he qualified for the feeding therapy, but it turns out he is delayed on ALL fronts - gross and fine motor skills, receptive and expressive language AND feeding, and he is also being recommended for play therapy. His final assessment took place yesterday - the most important one, the feeding assessment - and now we just hurry up and wait. Our big meeting with the Department of Health and Hygiene (yes, that's what the department is called... how could I make this stuff up?) happens May 20th, but time is of the essence. I go back to work in 4 1/2 months now, and each day that he doesn't eat is another day closer to the day I return to the classroom... and take the food source with me.

All sorts of irrational thoughts are flooding my brain and making me crazy. Have I failed him in some way? What have I done / not done with Oliver that I did / didn't do for Julia? Could I have prevented these delays in some way? What can we do differently now? What is causing these delays? Will he always be delayed, or will he at some point catch up and be on par with his peers? What's the long term prognosis here?

Of course there are the logistical questions too - seriously, FIVE therapists? What is our life going to look like? How will I parent Julia in any kind of an enriching way when our entire life is taken over by Oliver's therapy schedule? And by the same token, is Oliver's entire life going to be therapy? What about tumbling, and music, and swimming and all the fun things Julia got to do when she was a toddler, or just a trip to the playground? What about downtime? While we can't afford for me NOT to go back to work in the fall, how CAN we afford for me to go back to work? Clearly our son needs his Mama to be home?

I look at my boy and know he is a beautiful, happy little boy. I know he is bright and curious because I see the sparkle in his eyes. However, I an consumed by worry... what is going on in his little head and in his little body? And what can I do? Once again, I remind myself to breeeeeeeeeeeaaaaaaattttttthhhhhheeeeeee, and take this one step at a time. But then the crazy seeps back in, the panic starts to rise in my chest, and I leap ahead 53 steps...